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Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Treatment for sleep apnea begins with losing weight, quitting smoking, and treating any existing allergies. Therapies include continuous positive airway pressure (CPAP), an automatically adjusting form of CPAP known as auto-CPAP, bilevel positive airway pressure (BPAP) devices, and oral appliances designed to open the throat by bringing the jaw forward. There may be a need to treat diabetes, heart, or neuromuscular disorders as well. Surgical treatments include uvulopalatopharyngoplasty to remove tissue from the rear of the mouth and top of the throat, often along with removal of the tonsils and adenoids. Some patients may require bariatric surgery to help with sleep apnea.
Clefts and craniofacial
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Treatment options include CPAP at nightTonsillectomy and adenoidectomyUvulopalatopharyngoplasty (UPPP)Septal surgery to correct deviation and inferior turbinectomyMaxillary advancement (Le Fort I or III) or distraction but over-advancement may precipitate VPIGenioplastyCentral tongue reduction
Respiratory system
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Thoracic or abdominal surgery compromises the chest. Some procedures such as uvulopalatopharyngoplasty and tonsillectomy result in upper airway problems postoperatively. There may be physical narrowing through haematoma, oedema or bleeding. Analgesics and opiates increase respiratory depression. Nasal surgery with packs may impair the airway dramatically and pose problems from apnoea and from the packs. Occasionally it will be sensible to leave the patient intubated until they can be extubated while awake. Rarely the safe option will be elective tracheostomy.
Predictors of uvulopalatopharyngoplasty outcomes in patients with supine predominant positional obstructive sleep apnea: a prospective observational study
Published in Acta Oto-Laryngologica, 2023
Di Zhao, Yanru Li, Junfang Xian, Zhihong Lin, Zhewei Lou, Xin Cao, Dan Kang, Jingying Ye
Although continuous positive airway pressure (CPAP) is often used as the first-line therapy for OSA, its effectiveness is limited by variable adherence to therapy [4], necessitating the use of other alternative treatment approaches such as weight reduction, abstinence from alcohol and sedatives, positional therapy, oral device therapy, and upper airway surgery. Uvulopalatopharyngoplasty (UPPP) with tonsillectomy is still the most widely performed surgical treatment for OSA worldwide [5]. However, high body mass index (BMI) [6], high total apnea-hypopnea index (AHI) [7], complete concentric collapse at the palatal level and dilator muscle are all known factors contributing to the lower surgical success of UPPP [8]. Similarly, as the sleep position is a recognized factor affecting OSA severity, numerous studies have evaluated the influence of position-dependency on UPPP outcomes in OSA patients [9,10]. And some showed no differences were found in surgical success rates between NPP and POSA undergoing UPPP/Z-palatoplasty (ZPP). Li et al. found that severe POSA undergoing relocation pharyngoplasty had a greater chance of surgical success compared to NPP [10,11]. The verdict remains undecided.
Classification of facial phenotypes in Asian patients with obstructive sleep apnea
Published in Acta Oto-Laryngologica, 2022
Zishanbai Zhang, Huijun Wang, Dance Sun, Nanxi Fei, Yanru Li, Demin Han
Patients in cluster 3 had the highest BMI and most distinctive facial features. The face (upper, middle, and Lower Face Widths) and nose (Nasal Width) were the widest of all the cluster types. The Upper Lip Height was the longest, and the neck was the shortest and widest (Neck Circumference was the largest) of all the cluster types. This cluster had the highest AHI values, whereas the HP, RP, and PE airways were the narrowest. A larger AHI often indicates an overall increase in adiposity, which can also lead to fat deposition around the airway, resulting in upper airway narrowing and increasing extraluminal tissue pressure, thus increasing pharyngeal collapsibility [17]. In obese patients with multilevel airway obstruction, continuous positive airway pressure ventilation (CPAP) is considered the first-line standard of care for patients with OSA, and upper airway (UA) surgery is often recommended for the treatment of OSA patients who refuse or cannot tolerate CPAP [18]. Uvulopalatopharyngoplasty (UPPP) is the preferred and classic UA surgical option in patients with RP airway obstruction, which has shown an excellent reduction in AHI, even as a single procedure, with success and remission rates ranging from 35% to 95.2% in different studies [19]. In recent years, several new methods have been reported for RP airway surgery, such as transpalatal advancement pharyngoplasty (TAP), expansion sphincter pharyngoplasty (ESP), and Barbod reposition pharyngoplasty (BRP) and studies have shown that they are more effective than UPPP [19]. Weight loss may be another effective treatment option for this group of patients.
Internal carotid artery anomaly in oropharynx as a rare cause of sore throat
Published in The Aging Male, 2020
Amira Nasser Al Hail, Nasfareen Zada, Ahmad Al-juboori, Asharaf Ayinikunnan
The blood vessel anomalies of the head–neck area may result in death due to massive hemorrhage during head and neck surgery. Although anomalies of ICA are observed particularly on the posterior pharyngeal wall, we may confront them in various localizations. Because of these anomalies, the surgeon must always be aware of this risk during tonsillectomy, adenoidectomy, and uvulopalatopharyngoplasty operations [9,10]. In a review of the literature, four cases of injury of the ICA during adenoidectomy were reported, two with a fatal outcome. Knowledge of anomalies ICA in the head and neck region is important not only in routine oropharyngeal surgery but also in nasotracheal intubation. The nasotracheal tube can penetrate the oropharyngeal mucosa [4]. Anomaly of ICA needs no treatment as long as the patient does not have a cerebrovascular ischemic sign. Anomaly of ICA must be kept in mind in the evaluation of patients with sore throat associated with oropharyngeal mass and even in routine surgeries such as tonsillectomy and adenoidectomy. Patients should be informed of their condition, and this finding must be clearly documented in their health records for reference.